The article is devoted to the work of the Moscow Ambulance Station during the Great Patriotic War, which is one of the few that continued its activities during this period and accumulated significant work experience that should be studied and used. In peacetime, doctors and paramedics had to travel to fires, floods, explosions, building collapses, major traffic accidents, mass poisoning and other emergencies. However, the war required much more effort from the staff, because 283 people were drafted into the Red Army, and the rest had to work in difficult conditions with double the workload. The military situation affected all aspects of the Station’s life and activities. Working conditions at night became more difficult: there was a danger of collisions with oncoming cars, collisions with poles and trees, and in the dark it was difficult to find victims and patients, as well as provide them with medical care. Sometimes it was necessary to limit oneself to urgent transportation, postponing diagnosis and even first aid until delivery to medical institutions. There were special conditions when making calls during air attacks, and yet the Station did not stop its normal operation, only reducing its size to cases of extreme necessity. The ambulance service played an important role in ensuring the safety of the city during the most difficult days of Moscow’s defense. The timely assistance provided to victims of enemy air raids and accidents saved the lives of many citizens and allowed them to avoid more casualties.

INOCA (ischemia with nonobstructive coronary arteries) is a general term for different types of coronary artery disease which excludes an obstruction of the coronary arteries: vasospastic angina, microvascular angina and muscular myocardial bridge. According to coronary angiography data, 37–39% of patients don’t have hemodynamically significant stenoses of the coronary arteries. INOCA is assigned with significant quality of life limitations, decreased working capacity, the risk of major cardiovascular events is higher and survival rate is lower than in a healthy population. Two main pathogenetic mechanisms were studied and differentiated based on scientific data: microcirculatory dysfunction and vasospasm. Myocardial bridge is classified as structural vasospasm endotype. Coronary blood flow examination and an acetylcholine provocation test are the main diagnostical procedures, which can help to determine the leading pathophysiological mechanism of INOCA. Microvascular disease treatment is pretty similar to an obstructive coronary disease therapy with the possible addition of metabolic therapy. In vasospastic angina front-line drugs are calcium antagonists.

Patients with arterial hypertension associated with hypodynamia, unlike patients with arterial hypertension and optimal physical activity, were validly more likely to have higher body mass index and low-density lipoprotein, had tendency for higher levels of uric acid and loss of renal function. Myocardial and vascular wall alterations within such patients were characterized by tendency to reduced ejection fraction increase of interventricular septa thickness and posterior wall thickness, lower elasticity of vascular walls, increased systolic pressure in pulmonary artery. Patients with arterial hypertension and hypodynamia were more likely to have anxiety disorders. The obtained data prove that increased medical awareness, more active treatment and dispensary observation for such patients is required.

The objective: to study the relationship between the preoperative blood levels of the N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) and echocardiographic and pulmonary artery catheter (PAC) data before and after on-pump coronary artery bypass grafting (CABG), and to evaluate the biomarker as a predictor of postoperative myocardial dysfunction.

Material and methods. The study involved 63 patients aged 51[39–64] years with ischemic heart disease who underwent CABG. NT-proBNP blood level was determined before surgery. PAC and transesophageal echocardiography (TEE) data were analyzed at the stages: I – after anesthesia induction, II – at the end of surgery. Correlation analysis, logistic regression with calculation of odds ratio (OR) and 95% confidence interval (95% CI) and ROC analysis with calculation of area under ROC curve (AUC) were used.

Results. The median preoperative NT-proBNP blood level was 418.3[225.5–950.45] pg/mL. At stage I, NT-proBNP moderately correlated with mean and wedge pulmonary artery pressures, as well as with TEE parameters of the left ventricle (LV) sizes and function. At stage II, the biomarker moderately correlated only with TEE parameters. NT-proBNP >579 pg/mL was a predictor of LV area contraction fraction (LVACF) 605 pg/mL was a predictor of LV end-systolic area index (LVESAI) >9 cm2 / m2 (OR1.0015, 95% CI 1.0004–1.0026, p=0.008, AUC0.834) at the end of surgery. NT-proBNP10 (OR1.0016, 95% CI 1.0005–1.0026, p=0.003, AUC0.808), intra-aortic balloon pumping (IABP) (OR1.0019, 95% CI 1.0007–1.0030, p=0.001, AUC0.914) and intensive care unit length of stay >24 hours (OR1.0020, 95% CI 1.0007–1.0032, p=0.002, AUC0.771). NTproBNP >953 pg/mL was a predictor of the refractory heart failure (RHF) (OR1.0017, 95% CI 1.0006–1.0027, p=0.003, AUC0.866).

Conclusion. In 50.8% of patients before on-pump CABG, NT-proBNP blood level exceeded the upper limit of normal and varied within the range of 355–3232 pg/ml. NT-proBNP values moderately correlated with perioperative TEE parameters. There were no persistent correlations with PAC data. Preoperative NT-proBNP values of about 600 pg/mL were predictors of LVESAI >9 cm2 /m2 (AUC0,834) and LVACF 950 pg/mL was a predictor of RHF after on-pump CABG (AUC0.866).

Intraoperative hypotension is a clinical problem, the essence of which is a decrease in blood pressure during surgical procedures, leading to various complications in the intra- and postoperative period (acute kidney injury, postoperative delirium, stroke, and myocardial infarction). According to a number of studies, intraoperative hypotension is associated with increased hospital mortality in any operated patients, which explains the practical significance of this pathologic condition. Therefore, the issues related to the study of pathogenesis mechanisms, methods of prediction and prevention of intraoperative hypotension remain the subject of actual scientific search. For example, a number of studies are aimed at individual normal blood pressure determination, but this problem still unsolved. The pathophysiology of this condition is also a subject for study. It is known that during induction of anesthesia, the most common cause of hypotension is the side effects of drugs, and during the main stage of surgery it is blood loss. In both cases, the leading pathogenetic mechanism of hypotension is the insufficiency of the patient’s cardiovascular system to the onset of hemodynamic changes. Taking into account the heterogeneity of the cardiovascular system’s preoperative state in different patients and the extremely diverse format of surgical interventions, a personalized approach to the prediction, prevention and correction of intraoperative hypotension becomes of key importance. In recent years, the prediction and prevention of hypotension has become a subject of scientific interest. Hypovolemia is one of the main intraoperative hypotension’s pathophysiologic factors. Therefore, correction of volemic status is considered as a perioperative pressure reduction prevention method. As part of the personalized approach, the intraoperative hypotension prevention algorithms are used. These algorithms are based on the preoperative assessment of the patient’s volemic status using different instrumental tools. Some of such algorithms are summarized in the review.

Introduction. The presented study examined the strength of the quadriceps femoris muscle with different types of regional analgesia after total hip arthroplasty (THA).

Purpose. To evaluate the strength of the quadriceps femoris muscle using ileofascial (IFB) or pericapsular nerve group block (PENG) in the multimodal analgesia after THA.

Materials and methods. The study included 50 patients who were scheduled to undergo primary THA. Patients were randomly divided into two groups: group 1 (n=25) – patients who underwent IFB, group 2 (n=25) – patients who underwent PENG. In the postoperative period, the strength of the quadriceps femoris muscle was assessed using a muscle strength scale at 3–6–8–12–18–24 hours after surgery. The time of the first verticalization was analyzed. The level of pain syndrome at rest and during movement was recorded after 3–6–12–24 hours using a digital rating scale. The need for narcotic analgesics on the first day after surgery was noted.

Results. Patients with PENG had significantly higher quadriceps strength indicators after 3, 6 and 8 hours after surgery, when compared with patients with IFB (p <0,05). After 12, 18 and 24 hours, statistically significant differences in this indicator were not noted between the groups. The time of the first verticalization was shorter in patients of group 2. The level of pain syndrome at rest and during movement was significantly lower in patients of group 2 12 hours after surgery. No differences were noted in other periods. The number of opioid analgesics prescribed on the first day was significantly lower in the PENG group, compared with the IFB group.

Conclusions. The use of IFB and PENG in multimodal analgesia allows for effective control of pain syndrome indices in the postoperative period after ETS. The use of PENG allows for early activation and motor activity of patients due to the motor-saving effect on the quadriceps muscle of the thigh, which is one of the most important moments in preventing the development of complications and a positive outcome of surgical treatment.

Objective. To assess the influence of risk factors for predicting the development of postpartum hemorrhage.

Materials and methods. The retrospective study included 193 patients who gave birth in 2020–2024. The main group included: 87 patients who suffered postpartum hemorrhage (PPH) during childbirth and the control group – 106 women with normal childbirth without complications. Risk factors were assessed using a multilayer perceptron.

Results. In the main group, a large volume of postpartum blood loss (700 ml versus 190 ml in the control group) was due to the presence of gynecological diseases in women (vaginitis, uterine leiomyoma, cervical erosion, cyst of one or both ovaries) and gestational age (median 39.6 weeks).

Conclusions. Antenatal identification of risk factors in women entering labor through the natural birth canal provides the ability to predict PPH. Assessment of risk factors using neural network analysis allows for highly efficient, timely prediction of the development of PPH before birth.